Tom Sawyer: Mischievous or ODD?

Last weekend, my daughter and some of her classmates performed “The Adventures of Tom Sawyer,” the musical. Tom Sawyer is a mischievous and imaginative boy who comes up with all sorts of adventures for him and his friends. He often gets in trouble with authority, but is not mean-spirited. He just has lots of imagination!

Coincidentally, I have also been reading the book “The Last Normal Child: Essays on the Intersection of Kids, Culture, and Psychiatric Drugs” by Lawrence Diller, MD. This book focuses on ADHD and other childhood mental health diagnoses such as Oppositional Defiant Disorder (ODD), recounts Dr. Diller’s struggles with medicating “normal-acting” children to “help them ‘fit into’ their respective families and schools,” and describes some of the problems with our culture that exacerbate these problems.

I found the following analogy, in which Dr. Diller explains why he medicates some of these kids, most instructive (p. 15 in hardback):

If as a pediatrician I were presented with an epidemic of serious diarrhea occurring in my community, of course I would treat these children with hydration, oral or intravenous fluids if necessary, and other medications to help them get through their course of illness. But if I suspected that the epidemic was caused by drinking water that had been polluted by the effluent of an upstream factory, it would be unconscionable for me to remain silent. So I continue to medicate the Neds*—and the Pippi Longstockings and Tom Sawyers too—of my community even as I try to raise consciousness and criticize aspects of our society and culture that contribute to the epidemic of psychiatric diagnosis and treatment in children.

(*Ned is in reference to the absent-minded Professor Ned Brainard.)

The more I study the topic of childhood and adolescent mental health, the more I believe that our culture is not set up to accommodate the Pippi Longstockings and Tom Sawyers of our time. Rather, we expect these children to accommodate an under-stimulating education or unstable home environments.

The kids are not the problem! They are simply the victims of their environment and a medication-happy culture where drug companies are allowed to advertise freely to the public and push the “broken brain” theory. Kids are being medicated for being too young and to get better results on the SAT.

Let kids be kids. Let them run around in the woods. Let them explore, touch, build, mess up, and try again. Expect kindness, respect for all living things, and encourage them to do their best work—whether it’s helping with the dishes or doing their math homework.

And use medication only as a last resort for kids who are really, really struggling.

In my limited experience, Tom Sawyers and Pippi Longstockings are more interesting than in-the-box kids—mischief and all.